E. Lee Ford-Jones

The prevention and treatment of bacterial infections in children with asplenia or hyposplenia: Practice considerations at the Hospital for Sick Children, Toronto

Children born without a spleen or who have impaired splenic function, due to disease or splenectomy, are at significantly increased risk of life‐threatening bacterial sepsis. The mainstays of prevention are education, immunization, and prophylactic antibiotics. The availability of conjugate 7‐valent pneumococcal vaccines for use in children to age 9 years at least, as well as conjugate meningococcal C vaccine in some countries, for use beginning in infancy, appear to represent beneficial additions, but not substitutions, to previous recommendations for the use of polysaccharide 23‐valent pneumococcal and quadrivalent A, C, Y, W‐135 vaccines. Routine immunization against H. influenzae type b should continue with non‐immunized children older than age 5 years receiving two doses 2 months apart, similar to children who have not previously received conjugate pneumococcal vaccine in infancy. Annual influenza immunization, which reduces the risk of secondary bacterial infection, is also recommended for asplenic children and their household contacts. Many experts continue prophylaxis indefinitely although prophylaxis of the penicillin allergic child remains suboptimal.

Blastomycosis in Ontario, 1994–2003

Clinicians in Ontario should be aware of symptoms and areas where disease is endemic.

A Pharmacoeconomic Evaluation of 7-Valent Pneumococcal Conjugate Vaccine in Canada

The objective of this study was to evaluate the projected health benefits, costs, and cost-effectiveness of pneumococcal conjugate vaccination for infants and children aged <5 years in Canada. A health state model incorporating incidence, vaccine efficacy, costs, and transitional probabilities for the health states (well, meningitis, bacteremia, otitis media, pneumonia, and death) was constructed for a 10-year time horizon. Implementation of a pneumococcal conjugate vaccine program in Canada for each annual birth cohort of 340,000 persons observed over 10 years would be expected to save approximately 12 lives and 100,000 cases of pneumococcal disease over 10 years, resulting in total savings of

Nosocomial infections in the pediatric patient: an update.

67 million (Canadian dollars [Can

Enteric Fever in a Multicultural Canadian Tertiary Care Pediatric Setting: A 28-Year Review

]). Vaccination of healthy infants would result in net savings for society if the vaccine costs less than Can

Extrapulmonary Abscess Formation due to Pseudomonas cepacia in a Cystic Fibrosis Patient

50 per dose. Moreover, for a vaccine purchase price of Can

Methicillin-resistant Staphylococcus aureus carriage in a child care center following a case of disease

67.50, infant vaccination would cost society Can

Etiology of community-acquired pediatric viral diarrhea : a prospective longitudinal study in hospitals, emergency departments, pediatric practices and child care centers during the winter rotavirus outbreak, 1997 to 1998

79,000 per life-year gained. Pneumococcal conjugate vaccination is a potentially cost-effective means of pneumococcal disease prevention.

Streptococcus pneumoniae Carriage in Children Attending 59 Canadian Child Care Centers

Substantial progress has been made in measuring the burden of nosocomial infection in pediatric patients, particularly in certain populations (e.g., critical care, immunocompromised, chronic care, and patients with acquired immunodeficiency syndrome) and after certain procedures (e.g., central catheter lines and open-sternum cardiovascular surgery). Preventive measures, such as the use of goggles, gowns, and gloves, have been subjected to new and additional study. The following report is a summary of recent progress. A review of factors responsible for infection in various patient care populations and settings and recommendations for control are presented.

Hospitalization for Community-Acquired, Rotavirus-Associated Diarrhea: A Prospective, Longitudinal, Population-Based Study During the Seasonal Outbreak

We undertook a 28-year review of enteric fever at a large tertiary care pediatric center. Most cases occurred in children who visited friends and relatives in the Indian subcontinent, and there was significant antibiotic resistance. Documented vaccination rates were low, and many cases also had evidence of delays in diagnosis and treatment.